Since ancient times, “longevity of life” and even “immortality” have been expectations derived from human beings’ fear of death. Modern technology has also made the average age higher and higher, and the treatment of physical ailments of the elderly has become more advanced, but is the mental health of the elderly receiving the same care?

Mrs. Ronson, 68 years old, retired junior school teacher. I have been married to Mr. Ronson for almost 45 years. Her three children have grown up and have all moved out of their hometown to work in other places. Mrs. Ronson and Mr. Ronson have begun to enter the “empty nest period”, which is when their children all leave home because of their own life plans, leaving only their parents living alone. Originally, Mrs. Ronson would join the local folk dance club in the community and work as a volunteer with a church religious group.

Instead, Mr. Ronson always stays at home, reading newspapers and watching TV all day long. Mrs. Ronson has been prone to quarrels with Mr. Ronson recently, and she also has symptoms of heart palpitations. Her sleep quality was getting worse and worse, and she would feel panic attack her late at night, leaving her unable to breathe. She always felt very tired during the day.

Mrs. Ronson went to the cardiology department, but her blood pressure was slightly high and she still had a little arrhythmia. The doctor said that it could be controlled by taking medicine. But Mrs. Ronson’s shoulder and neck pain, and irritability did not disappear. As her appetite worsened, Mrs. Ronson went to the gastroenterology, hepatobiliary and biliary department, but the doctor said she couldn’t find the problem. Because of dizziness, Mrs. Ronson went to the neurology department and had an MRI, but there were no major findings. In the end, a neurologist discovered that she had obvious anxiety. After being referred to the psychiatric department, after psychological consultation and taking antidepressant drugs, her condition gradually improved.

The problem with the mental health of the elderly is that they have a wide range of aspects. No matter whether it is physical, psychological, social and other factors, they all have an impact. It is a complex issue. Whether it is the seniors themselves or the relatives and friends of their elders, when symptoms related to mental illness appear, they may be less sensitive. Just like the above-mentioned case of Mrs. Ronson, she went to various departments for examination and thought it was a physiological problem. After understanding the situation, I finally discovered that she actually needed to go to the psychiatric department for a comprehensive evaluation.

For the physical and mental well-being of ourselves, our families, and our close friends, we should all be more alert to the emotional ups and downs of the elderly. Before we go into more in-depth discussion, we must first understand the definition of mental health.

Mental health definition

According to the definition of the World Health Organization (hereinafter referred to as WHO), mental health is not just “the absence of mental illness”, but a concept: “In a healthy state, everyone can use their own abilities to cope with The pressure of daily life. Can also demonstrate a high degree of work effectiveness and contribute to society.

For the elders, in addition to strengthening their mental health, they also need to face the impact of aging on themselves.

How aging affects the mental health of the elderly

Aging is a natural phenomenon, and the body and mind interact with each other. The impact on the elderly can be divided into the following three categories:

1. Physical fitness declines due to aging, causing frustration.
   
2. Immunity decreases due to aging, causing concern about death.
   
3. Due to aging, the sensory system declines, resulting in distrust of things around us.

Psychological challenges for the elderly

Silver-haired people find that their aging is in sharp contrast with the ever-changing external world, which in turn triggers strong negative emotions:

1. A Sense of Loss: After retirement, losing social status and being unable to identify with oneself.
   
2. A Sense of Useless: Feeling that one has no way to contribute to society.
   
3. A Sense of Self Pity: Feeling that you will be disliked as you age, and you will get angry easily.
   
4. A Sense of Alienation: For the elderly living in nursing homes, because their family members cannot take care of them personally, they feel isolated from relatives, friends and society.
   
5. Suspicion: The body function deteriorates, the senses are not sharp enough, and one begins to doubt one thing or the other.
   
6. Grief: Feeling pain and loneliness due to the death of a relative or friend.
   
7. A Feeling of Fear: Fear of being unable to control aging, death, illness, and pain.
   
8. A Feeling of Helplessness: The inability to achieve your dreams due to aging.
   
9. A Feeling of Dependency: Turning to children for help in everything and feeling unable to be autonomous.
   
10. A Feeling of Ambivalence: Needing to rely on family members for care, yet refusing to accept old age, causing inner conflict.
    
11. Self-blame: regret and blame for past decisions.

Common mental illnesses among the elderly

1. Dementia
   Dementia, formerly known as Alzheimer’s disease, is not a single disease, but a syndrome, mainly caused by acquired intellectual deterioration. The clinical symptoms are mainly memory degradation, coupled with cognitive function impairment. For example: deterioration of calculation ability, spatial sense, language logic, etc. In addition, patients may also experience symptoms of mental illness such as personality changes, mood disorders, abnormal behavior, and even hallucinations or delusions.
   
   The causes of dementia are complex. Generally speaking, brain diseases are the main causes. Studies show that 12% of dementia is reversible. Therefore, early detection and early treatment are very important. Even though there is currently no drug that can completely restore brain function. However, the emotional symptoms associated with dementia can be improved after the psychosomatic physician gives drugs.
   
2. Geriatric depression
   Depression in the elderly is actually more common than we think. Symptoms include:
   
   • Increased body complaints
   • Increased thoughts about illness
   • Increased mood irritability
   • Increased thoughts related to death
     
     It can be said that the symptoms of geriatric depression are not very obvious, and patients with geriatric depression often suffer from various chronic diseases. It is worth noting that geriatric depression is not a normal aging process, that is to say, you should not have a bad mood or weird personality as you get older. Elderly depression is treatable, and we should respond proactively to restore the vitality that our elders deserve.
     
3. Anxiety
   Anxiety and related disorders include:
   • Generalized anxiety disorder
   • Phobia
   • Panic disorder
   • Obsessive-compulsive disorder
   • Post-traumatic stress disorder
     
     There are many symptoms of anxiety disorders, which can be summarized into three types using autonomic nervous system disorders:
   • Behavioral: Sitting on pins and needles, tight muscles, etc.
   • Emotionally: fear, worry, irritability, inability to concentrate, etc.
   • Physiologically: rapid heartbeat, chest tightness, dry mouth, dizziness, night sweats, frequent urination, etc.
     
     Although anxiety does not necessarily have a specific “trigger”, as the elderly grow older, they will encounter the psychological challenges emphasized in the previous paragraphs, and their feelings of uneasiness and anxiety will also increase. If I understand that these mental symptoms are very likely to occur during the “transition period” from middle age to old age, then we can also create a more supportive environment for the elderly to treat them.
     
4. Substance abuse
   Substance abuse is actually an old name. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5) published by the American Psychiatric Association, this situation was renamed It is Substance use disorder, which is translated as “substance use disorder” or “substance use disorder” in Chinese.
   
   Substance use disorder is not just about addiction, but when drugs are used in the wrong way, leading to intoxication, poor effectiveness of medication, dependence, etc. For example, the doctor originally prescribed only one kind of sleeping pill, but the elder went to another clinic to see a doctor and took three or four other sleeping pills to help him fall asleep. Or the elders treat sleeping pills like candy and take them before going to bed at night, but also take them during a nap at noon. These behaviors that are not prescribed and increase on their own are substance use disorders.
   
   Most people think of this as tobacco, alcohol, and drugs. However, Taiwan’s health insurance system makes it easy for everyone to obtain a variety of drugs, and elders who are prone to chronic diseases, insomnia and other symptoms are more likely to be “medicated” and are more likely to be addicted to drugs. In fact, substance abuse among the elderly in Taiwan is more serious than we imagine. If medical staff or family members are not highly alert to this problem, and the elders in the family hide their bad habits, it is very easy to underestimate the danger and delay treatment, causing regrets.

How seniors can stay mentally healthy

1. Maintain physical health.
   
2. Be willing to accept old age, accept old age and refuse to admit defeat.
   
3. Live till old age, learn till old age, and devote till old age.
   
4. Cultivate hobbies and enrich your life.
   
5. Continuously build and maintain good interpersonal relationships.

Death is inevitable, but it should be said first that old age is inevitable. Before facing death, we should take a good look at the overall impact of aging on us. Don’t just focus on taking care of your body and neglect your mental health. If the elders are in a bad mood, they will not be properly relieved, accompanied, listened to, or even treated. It is easy for the elderly to “go astray” and end up in an irreversible tragedy!

In recent years, “reverse ageing” has become a trend. People only care about not looking old and getting rid of ailments. In fact, living a meaningful and happy life as a senior is well worth our efforts.